| NPI | 1710996533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 28525) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA1515) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2019-03-27 |